An employer’s coalition has launched a plan to expand what Indiana companies know about the health care insurance they buy for their workers.
Earlier this month, the Indiana Employers Quality Health Alliance mailed invitations to several insurers asking them to participate in their 2005 eValue8 performance assessment.
The concept is nothing new. However, this year, alliance President Dr. Ned Lamkin hopes more insurers respond and their ensuing report reaches a wider audience of employers, right before they choose their health insurance plans for the next year.
Eventually, Lamkin and others involved hope eValue8 becomes a national standard for gathering information about insurers.
Every year, Lamkin’s coalition sends out a thick survey that aims to profile what insurers provide and how well they provide it. Few questions go unasked.
The survey attempts to measure services provided, and communication with providers and enrollees. It seeks answers that detail the insurer’s Internet capabilities or how it monitors diabetic patients and most everything in between.
The National Business Coalition on Health works with alliances such as Lamkin’s across the country to process all this data, said Dorothy Jeffress, coalition assistant vice president.
The Washington, D.C.-based not-forprofit also works with academic experts and officials at the Centers for Disease Control and Prevention to figure out what goes in these surveys, which also are known as requests for information.
“It’s not just throwing everything out there we can get to stick,” Jeffress said. “We pull in top public health experts from around the country to help inform the content.”
After the insurer returns the survey and supplies the necessary supporting documents, the coalition arranges a meeting. Employers and insurers go through the results together to make sure there are no misunderstandings on either side.
“There’s a nice dialogue back and forth between the employers and the health plans as part of the process,” Lamkin said, adding that the process is not adversarial.
However, the meetings also provide a reality check for the insurers. If they distort an answer, an employer who uses their plan might catch it, Jeffress noted.
The final report provides category scores. It also sets a benchmark of best scores from around the county so the insurer can measure room for improvement, Lamkin said.
That reflects another goal of these reports. Aside from providing insight for the insurance buyer, the process encourages insurers to improve.
“The idea is, we’re all in this together and we all want to do the best job we can,” Lamkin said.
Lamkin’s alliance collects the survey data in March, and plans to distribute final reports this summer so employers can use them to decide on a benefit plan.
Last year, few insurers took a stab at these thick forms for the Indiana Employers Quality Health Alliance. The formerly named Anthem Inc. and M-Plan Inc. were the only health maintenance organizations to participate.
That meant the alliance profiled the majority of central Indiana’s HMO business. But HMOs probably make up only 20 percent of the total market, according to Lamkin. Preferred provider organizations make up most of the rest.
Last year, the Indiana alliance invited some PPOs to participate for the first time, but none accepted. Lamkin said his alliance didn’t have a solid grasp on the local PPO market, and some of those organizations already participated in other surveys.
This year, Lamkin sent out a half-dozen invitations to PPOs. He remains unsure about the response, aside from Anthem, which plans to return PPO forms this year, too.
PPOs, Lamkin said, are tougher to evaluate.
“They’re different from HMOs; they offer basically discounted networks, and what you see is what you get,” he said.
The Indiana alliance started profiling HMOs several years ago, but the project has remained in an extended infancy. Lamkin’s coalition normally distributes the reports only among its nine members, which include some big employers like the state of Indiana and General Motors Corp.
This year, he hopes to make reports available statewide through chambers of commerce and other vehicles.
That report has plenty of competition.
Every year, about 50 requests for information cross the desk of Kim Byrwa, director of health promotions and disease management for Anthem Blue Cross and Blue Shield’s Central Region, a WellPoint Inc. subsidiary.
Many human resources consulting firms conduct these surveys, and many have different sets of questions they want to ask.
The National Business Coalition on Health uses the eValue8 surveys to gather information on 200 HMOs and another 100 PPOs across the country. Those numbers received a boost last year, when the consulting firm Watson Wyatt Worldwide joined their effort.
Lamkin and Jeffress hope the eValue8 form, which is shared by about 12 coalitions across the country, becomes the standard someday. Completing one form-instead of 50-would save insurers time, resources and money, Lamkin noted.
Rick Altstadt, M-Plan’s marketing vice president, has a hard time believing standardization will happen. He doesn’t see how all the employers and consultants could ever agree on a single set of questions.
Jeffress thinks it’s possible. She said the eValue8 request is easily the most comprehensive version out there.
“We can compete on what we do with the results,” she said. “We shouldn’t compete on what the questions are.”
Getting ahold of a completed report can be a pricey endeavor. Some employer coalitions give them out as part of a membership. Others can charge several thousand dollars for a copy, Jeffress said.
Both M-Plan and Anthem have filled out the Indiana alliance’s forms for several years now. Neither plans to stop.
Anthem’s Byrwa sees the forms as a way to grow her company’s business by highlighting what it can do.
“We want to be able to show that all of our doctors and all of our network initiatives are high-quality, and this is a great way to illustrate that,” she said.
M-Plan started doing it because company officials hoped it would eventually become the standard for requests for information. They keep doing it because “it’s what our customers are asking us for,” Altstadt said.
He also sees it as a way to get the MPlan name on the minds of national employers who have a presence in Indiana. Most companies with more than a thousand employees use the information from these requests for information to decide on a health care plan.
Then there’s the improvement angle. MPlan and other insurers can compare how they approach a situation and devise a best practice.
“There is the opportunity to learn from your peers and improve upon what you’re already doing,” he said.